Provider Demographics
NPI:1972728921
Name:HALLOWELL-WEST MEDICAL CENTER
Entity type:Organization
Organization Name:HALLOWELL-WEST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-350-4595
Mailing Address - Street 1:140 MARINE VIEW AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2133
Mailing Address - Country:US
Mailing Address - Phone:858-350-4595
Mailing Address - Fax:858-350-4596
Practice Address - Street 1:140 MARINE VIEW AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2133
Practice Address - Country:US
Practice Address - Phone:858-350-4595
Practice Address - Fax:858-350-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17903103G00000X
CAG50175103TP0016X
CAA69151103TP0016X
CA40523106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty